Brendan Scott

Classic hypoxic training interventions have focused on augmenting endurance performance by increasing oxygen-carrying capacity. Innovative applications of hypoxia have recently been explored, including during resistance training to improve muscular development and physical performance. Substantial evidence now supports the use of localized hypoxia during low-load resistance training for muscle size and strength, which is achieved by wearing inflatable cuffs proximally on the limbs to restrict blood flow and oxygen delivery to the muscle. This technique is known as blood flow restriction (BFR) training. Another approach involves resistance training while breathing hypoxic air (RTH). This method allows an individual to train trunk and hip muscles under the same hypoxic stimulus as limbs even during heavy lifts, unlike BFR. While some research suggests that RTH augments muscle size and strength compared with normoxic training, these effects are inconsistent, possibly due to substantial heterogeneity between study methods. This chapter explores how localized and systemic hypoxia may augment responses to resistance training, covering reported training adaptations and their likely physiological mechanisms, and concludes by highlighting practical implications of these techniques.